Personal Independence Payment (PIP) is a benefit that helps people with disabilities and long-term health conditions pay for the extra costs caused by their conditions. PIP decisions are made by assessors working for private companies on behalf of the Department for Work and Pensions (DWP). The assessor will review your PIP claim form, along with any additional evidence you provide. They will then decide whether you should be awarded PIP, and if so, what rate you should receive. However, the assessor’s decision is not necessarily final. You have the right to challenge a PIP decision you disagree with by asking for mandatory reconsideration and appealing to a tribunal. So while PIP assessors make the initial decision, you can take steps to try and get it changed if you believe the decision is wrong.
Who are the PIP assessors?
PIP assessments are carried out by health professionals working for two private companies – Independent Assessment Services (formerly called Atos) and Capita. These companies have contracts with the DWP to assess PIP claims. The assessors are mostly nurses, physiotherapists, occupational therapists, paramedics or doctors. They consider the information provided in your PIP claim form, along with any additional evidence you submit. The assessor will then determine:
– Whether your condition or disability meets the PIP criteria
– Which PIP components you should receive (daily living and/or mobility)
– Whether you should get the standard or enhanced rate for each component
So the PIP assessor makes the initial decision about your claim. However, you have the right to challenge their decision if you believe it is wrong.
Can you appeal a PIP assessor’s decision?
Yes, if you disagree with the PIP assessor’s decision, you can challenge it. There are two stages to the appeals process:
1. Mandatory reconsideration – You ask the DWP to look at the decision again and reconsider it.
2. Appeal – If reconsideration is unsuccessful, you can appeal to an independent tribunal.
Mandatory Reconsideration
If you disagree with the PIP decision, the first step is to apply for mandatory reconsideration. This means asking the DWP to look at the decision again. You need to apply within 1 month of the date on your decision letter.
To apply, contact the office that handles your claim and explain why you disagree with the decision. Provide any new evidence you have that could help your case. A DWP decision maker, who was not involved in the original decision, will review your claim and make a new decision.
You will be sent the outcome within 14 days. If your award is changed, you will receive backdated payments. If mandatory reconsideration is unsuccessful, you can then lodge an appeal.
Appeal to a tribunal
If your mandatory reconsideration is rejected, you can appeal the decision to Her Majesty’s Courts and Tribunal Service (HMCTS). Your appeal will be heard by an independent panel legally qualified member:
– A judge
– A doctor
– A disability member
The panel will consider all the evidence and make an independent decision. Around 70% of PIP appeals are successful, so going to tribunal is worthwhile if you have a strong case.
To start your appeal, complete form SSCS1 and send it to HMCTS within 1 month of your mandatory reconsideration notice. HMCTS will send you an acknowledgement letter and a date for your tribunal hearing. You can submit evidence up to 14 days before your hearing.
Is the tribunal’s decision final?
In most cases, the tribunal’s decision will be legally binding. This means the DWP must implement the decision and pay you any backdated PIP owed. However, in limited circumstances, the DWP can appeal a tribunal’s decision. This would involve going to the Upper Tribunal and is very rare. Less than 1% of PIP appeals continue past the initial tribunal.
So for the vast majority of claimants, if the first-tier tribunal awards you PIP, that decision will be final and cannot be challenged further. The exception would be if the DWP appeals to the Upper Tribunal and you have to attend a second hearing. But this only happens in a tiny fraction of cases.
When can the DWP appeal a tribunal’s decision?
The DWP can only appeal a tribunal’s ruling in very limited circumstances:
- The tribunal made an error in law – For example, they misinterpreted regulations or legislation
- The tribunal’s decision conflicts with PIP case law
- The tribunal overlooked a legislative provision or binding court decision
- The original tribunal had no jurisdiction to make the decision it did
If the DWP believes one of these narrow grounds applies, they can lodge an appeal with the Upper Tribunal Administrative Appeals Chamber. But this is extremely rare – government figures show less than 1% of PIP appeals are escalated further by the DWP.
How often does the DWP appeal tribunal decisions?
DWP appeals of PIP tribunal rulings are very uncommon. Here are the official statistics:
- In 2017, only 0.14% of PIP decisions (1,200 out of 853,000) were appealed by the DWP to Upper Tribunal
- In 2018 this dropped to 0.04% (300 out of 921,000)
- In 2019 it was 0.03% (258 out of 928,000)
So while the DWP can appeal a tribunal’s decision, in reality this almost never happens. Between 2017 and 2019, the DWP appealed only 0.03% to 0.14% of first-tier tribunal decisions.
This shows that if you win your PIP appeal at tribunal, the ruling will be final in over 99% of cases. The DWP appeal rate is extremely low and falling.
Conclusion
In summary:
- PIP claims are initially assessed by health professionals working for assessment providers
- These assessors decide if you will get PIP and what rate you receive
- You can challenge the assessor’s decision through mandatory reconsideration and appeal
- Around 70% of PIP appeals at tribunal are successful
- For over 99% claimants, the tribunal’s decision will be final
- The DWP rarely appeals tribunal rulings due to the very limited grounds to do so
So while PIP assessors make the first decision on your claim, you can take steps to overturn their decision if it is wrong. For the vast majority of claimants who appeal, the tribunal’s ruling will be the final say on their PIP award.